Cognitive Behavior Therapy

CBT tools are a very useful part of counseling. For instance, when we have a Sad Thought, or Experience, it often leads to a Sad Feeling. Since most of our thoughts arise from nothingness this happens to us all the time. In fact, we have little direct control over these thoughts and feelings, or so it appears.

Often times, we will then cope, or try to feel better, by Escaping our Distress through Anger, Control, Cravings, or Numbing Out. This coping strategy benefits us by providing Temporary Relief but also leads to unwanted Consequences. We then imagine that this distressing experience will continue or get worse. We call this Catastrophizing.

Example

An example can help make this seem a little more straight forward. Imagine a woman, lets call her Janet. Janet has low self esteem and is hoping to meet someone while she is out at a bar with girl friends. Janet is a bit overweight, 15 pounds or so. Janet, unfortunately thinks of her self as fat and struggles with binge eating and drinking to cope with distressing thoughts.

While sitting at the bar Janet sees a man she is attracted to, lets call him Tim. Tim makes eye contact with Janet and she feels a connection. Then all of a sudden, Janet’s phone comes to life, she just received a text from her friend Bob, who she sees from time to time. Bob is lonely and wants to get together with Janet tonight, but she is busy and a little bit buzzed from a couple of glasses of wine. She wants to ignore the text, but instead responds by saying she is busy. Bob knows this tone and says she is out trolling for men again and makes a rude comment about her weight.

Now, Janet has just experienced a sad and frustrating event – Bob’s comment about her trolling for men and being overweight.This leads to the sad feeling of being lonely and unwanted. Janet has a choice according to the model above. She can either explore this distressing thought and feeling or she can escape by numbing out with another drink and ordering some of those tasty appetizers she saw on the menu – comfort food. The more Janet chooses to cope with this habit the more ingrained it becomes into her response to distressing thoughts and experiences.

But there is another Choice. We can use CBT tools to choose to Explore the distressing thoughts and feelings. We do this by slowing down the process of pushing away painful thoughts and emotions, through inquiry and openness. This is really challenging and the last thing we want to do. Paradoxically, it is often the only thing that will help.  

CBT Tools – Cognitive Distortions

Through this process we can become aware of our thought and start to Identify Patterns. These are commonly called Cognitive Distortions in CBT. These patterns are helpful in that they quickly allow us to assess risk and reward to determine how to handle a situation. The problem is many of these patterns have distorted thoughts that were formed when we were younger or in powerless and traumatizing situations. These patterns are ingrained and highly resistant to change at times. The next step in the process is to Confront these patterns.

There are many CBT tools and techniques to confront these patterns.  One common technique is to question the evidence for the thought, feeling or belief.  We might ask the belief:

what evidence is there that this is true?

Is this always true?

Has there ever been a time where this wasn’t the case?

How is holding this belief helping me?

We can imagine putting the thought on the witness stand and questioning it’s credibility. This process is much more powerful when questioned by another person, or a trained therapist. It also helps to write down these thoughts to make them concrete and step out of the repetitive loop. As we deepen our questioning the thought may start to fade away of it’s own weight and convoluted nature. When this happens we start to develop  mastery over these thoughts and related emotions. We sense the possibility of creating space to understand what these beliefs and emotions are here to teach us and then to respond appropriately.

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Who Does CBT Work Best For

CBT is a powerful tool for analytic, rational people who have a strong connection with their mind. That being said, often the problem is not confronting our thoughts, but experiencing and working with our emotions. For people who are cut off from their emotions CBT may feel really good, but miss some of the more important parts of treatment. For people who embrace their emotions deeply, CBT may feel too intellectual to make much of a dent in dysfuntional habits of mind and body.

Since CBT has been more researched than any other modality, and insurance companies love it because it is logical and easy to follow it has become the most recommended treatment for most mental health issues. The method of CBT that we use is designed by David Burns and called TEAM CBT.

References

Information provided on this site does not constitute a patient therapist relationship, and should be used under the guidance of a licensed mental health professional. Information presented on this page was written by James Meyer, LCSW Lead Counselor and founder of Lions Heart Counseling Sacramento.